Sex headache

The International Headache Society has divided sex-related headaches into two major categories:

1. Primary headache associated with sexual activity: This is further divided into:
   • Pre-orgasmic headache: This type of headache sets in before the orgasm. It can start during sexual activity and increase in intensity as sexual excitement rises. Symptoms include a dull ache in the head and neck, along with awareness of contraction in the muscles of the neck and/or jaw. This type of headache cannot be attributed to another disorder or underlying condition.
   • Orgasmic headache: Sudden severe (“explosive”) headache which occurs at the time of orgasming. This type of headache, too, cannot be attributed to another disorder.

2. Secondary headache disorder: This type of headache is connected to spontaneous (or idiopathic) low CSF pressure. CSF or cerebrospinal fluid provides cushioning to the brain and spinal cord. When CSF pressure decreases, the brain can sag slightly, stretching the tissues and membranes that generally keep the brain in place. This stretching causes a headache.
   Low CSF pressure can be a serious condition that should be investigated by a medico as soon as possible.

The symptoms of sex-related headaches can vary:

• Some people may complain of a dull ache in the head and neck that increases as sexual excitement increases.
• Some people may complain of sudden, sharp, throbbing headache that happens just before or at the moment of orgasm.
• Some people can experience both headaches before and during orgasm.

These headaches can either last for several minutes or can stay for hours or even two to three days. It is also seen that most of the patients with sex-related headaches also suffer from migraine.

If the person presents with the following neurological symptoms, they may require immediate medical assistance:

• Neck stiffness
• Vomiting
• Photophobia (discomfort or pain in the eyes and head due to light exposure)
• High blood pressure
• Altered consciousness
• Confusion
• Weakness in the left arm or the right leg 
• Plegia (paralysis)

There is no certain cause of sex-related headaches. The majority of sex headaches, especially those which have an abrupt onset and slowly increase with time, have a benign origin and do not have any underlying condition. They are sometimes associated with migraines. 

However, the headaches which last for a longer period of time and are associated with a stiff neck, nausea and sometimes loss of consciousness may be caused by an underlying condition. Some of the underlying reasons for sex headaches could be:

• Brain aneurysm (bulging or ballooning of the wall of an artery inside your brain 
• Arteriovenous malformation (the entanglement of arteries and veins in the brain)
• Stroke
• Coronary artery disease
• Inflammation in the brain 
• Drugs like birth control pills, amiodarone, pseudoephedrine and cannabis

The doctor may ask for a detailed history of the frequency and intensity of headaches. The doctor may prescribe you the following tests if they suspect any underlying condition:

• Computed tomography scan of head: A CT scan is done to check for any abnormalities in the skull, paranasal sinuses or brain.
• MRI: A head MRI scan is done to find out the details of any injury or damage to the brain.
• Lumbar puncture: Lumbar puncture is also known as spinal tap and it is done to find out any abnormalities in the cerebrospinal fluid.
• Cerebral angiography: This test helps in finding any abnormalities and/or blockages in the blood vessels of the brain.
• Urinary catecholamine: Catecholamines are released in excessive amounts in the body when there is any physical or emotional stress. Catecholamines in urine can also suggest a tumour in the body.

The treatment of sex-related headaches is done with the help of medications and self-management.